Subscribe to RSS
DOI: 10.1055/s-0042-113310
Akute Nierenschädigung
Wie kann sie verhindert werden?Acute kidney injury – How can it be prevented?Publication History
Publication Date:
17 August 2016 (online)
![](https://www.thieme-connect.de/media/klinikarzt/20160708/lookinside/thumbnails/354_10-1055-s-0042-113310-1.jpg)
Bereits der Titel dieser Übersichtsarbeit ist vom Herausgeber sehr optimistisch gewählt, denn er suggeriert, dass die akute Nierenschädigung verhindert werden kann. „Akute Nierenschädigung“ ist die seit 2007 einheitliche Definition, die den unterschiedlich auslegbaren Begriff “akutes Nierenversagen” abgelöst hat. Dies erfolgte auch mit der Zielsetzung, in Zukunft möglichst eine geringgradige Schädigung der Niere frühzeitig zu erkennen und dann durch Maßnahmenbündel ein Versagen der Niere verhindern zu können. Leider gibt es bisher keine singuläre pharmakologische oder sonstige Maßnahme die dies zulassen würde, sodass in dieser Übersicht das frühzeitige Erkennen von Nierenschädigungen und die Aufklärung medizinscher Mythen in Bezug auf die akute Nierenschädigung im Mittelpunkt stehen.
The title of this paper is already a bit euphemistic as it implies that prevention of acute kidney injury is indeed possible, which is unfortunately not the case. The uniform definition of acute kidney injury, which was first instituted in 2007 was however choosen to detect injury very early in order to avoid progression to kidney failure, eventually requiring renal replacement therapy. This can however not be done by a magic (pharmacological) bullet by rather by a bundle of measures aimed to predict and diagnose AKI early and to prevent progression to advanced injury or failure. Hence this paper will focus on those measures and will also clarify medical myths in the field of AKI, like the benefit of overhydration in prevention of AKI.
-
Literatur
- 1 Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network (AKIN): report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31
- 2 Chertow GM, Burdick E, Honour M et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005; 16: 3365-3370
- 3 Bihorac A, Chawla LS, Shaw AD et al. Validation of cell-cycle arrest biomarkers for acute kidney injury using clinical adjudication. Am J Respir Crit Care Med 2014; 189: 932-939
- 4 Koyner JL, Shaw AD, Chawla LS et al. Tissue Inhibitor Metalloproteinase-2 (TIMP-2)IGF-Binding Protein-7 (IGFBP7) Levels Are Associated with Adverse Long-Term Outcomes in Patients with AKI. J Am Soc Nephrol 2015; 26: 1747-1754
- 5 Bagshaw SM, Haase M, Haase-Fielitz A et al. A prospective evaluation of urine microscopy in septic and non-septic acute kidney injury. Nephrol Dial Transplant 2012; 27: 582-588
- 6 Montero-Melendez T, Patel HB, Seed M et al. The melanocortin agonist AP214 exerts anti-inflammatory and proresolving properties. Am J Pathol 2011; 179: 259-269
- 7 Pickkers P, Heemskerk S, Schouten J et al. Alkaline phosphatase for treatment of sepsis-induced acute kidney injury: a prospective randomized double-blind placebo-controlled trial. Crit Care 2012; 16: R14
- 8 Thrasos Announces Promising Results for Phase 2 THR-184 Dose Ranging Clinical Study for the Prevention of Acute Kidney Injury (AKI). 2016; Ref Type: Internet Communication
- 9 Zarbock A, Schmidt C, Van AH et al. Effect of remote ischemic preconditioning on kidney injury among high-risk patients undergoing cardiac surgery: a randomized clinical trial. JAMA 2015; 313: 2133-2141
- 10 Hausenloy DJ, Candilio L, Evans R et al. Remote Ischemic Preconditioning and Outcomes of Cardiac Surgery. N Engl J Med 2015; 373: 1408-1417
- 11 Meybohm P, Bein B, Brosteanu O et al. A Multicenter Trial of Remote Ischemic Preconditioning for Heart Surgery. N Engl J Med 2015; 373: 1397-1407
- 12 Kooiman J, Sijpkens YW, de Vries JP et al A randomized comparison of 1-h sodium bicarbonate hydration versus standard peri-procedural saline hydration in patients with chronic kidney disease undergoing intravenous contrast-enhanced computerized tomography. Nephrol Dial Transplant 2014; 29: 1029-1036
- 13 Carlier M, Carrette S, Roberts JA et al. Meropenem and piperacillin/tazobactam prescribing in critically ill patients: does augmented renal clearance affect pharmacokinetic/pharmacodynamic target attainment when extended infusions are used?. Crit Care 2013; 17: R84
- 14 Raimundo M, Crichton S, Syed Y et al. Low Systemic Oxygen Delivery and BP and Risk of Progression of Early AKI. Clin J Am Soc Nephrol 2015; 10: 1340-1349
- 15 Miyatake S, Ichiyama H, Kondo E, Yasuda K. Randomized clinical comparisons of diclofenac concentration in the soft tissues and blood plasma between topical and oral applications. Br J Clin Pharmacol 2009; 67: 125-129
- 16 Zhang L, Chen Z, Diao Y et al. Associations of fluid overload with mortality and kidney recovery in patients with acute kidney injury: A systematic review and meta-analysis. J Crit Care 2015; 30: 860-813
- 17 Hanrahan TP, Harlow G, Hutchinson J et al. Vancomycin-associated nephrotoxicity in the critically ill: a retrospective multivariate regression analysis*. Crit Care Med 2014; 42: 2527-2536
- 18 Pickering JW, James MT, Palmer SC. Acute kidney injury and prognosis after cardiopulmonary bypass: a meta-analysis of cohort studies. Am J Kidney Dis 2015; 65: 283-293
- 19 Cerda J, Ronco C. Modalities of continuous renal replacement therapy: technical and clinical considerations. Semin Dial 2009; 22: 114-122
- 20 Lo LJ, Go AS, Chertow GM et al. Dialysis-requiring acute renal failure increases the risk of progressive chronic kidney disease. Kidney Int 2009; 76: 893-899
- 21 Alfaadhel TA, Soroka SD, Kiberd BA et al. Frailty and Mortality in Dialysis: Evaluation of a Clinical Frailty Scale. Clin J Am Soc Nephrol 2015; 10: 832-840
- 22 Harel Z, Wald R, Bargman JM et al. Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. Kidney Int 2013; 83: 901-908
- 23 Schmidt JJ, Beutel G, Kielstein JT. Diagnosis and pathophysiology of acute renal failure - is prevention possible?. Dtsch Med Wochenschr 2015; 140: 245-249